Research questionnaire for Dr. Wu s non-bone-breaking surgery

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Oliver Hampton
6 years ago
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1 Research questionnaire for Dr. Wu s non-bone-breaking surgery Part 1. Your Personal information 1. Bunion duration: Approx. year(s) 2. Family history of bunion deformity (may circle more than one): Mother Yes not sure; Father Yes not sure Grandparents Yes not sure; Brother or sister --- Yes not sure Other relatives (please specify) : 3. Did you wear high-heel shoes at all? (For female patient) Yes: a. Duration: approx. years b. Frequency: daily; about 3 days/week; once a week; less c. Usual height: Inch 4. Any sports and/or exercises for > 3 years? (please tick as many as relevant) ne; Jogging; Dancing; Hiking; Tennis; Others: 5. Any trauma to big toe/foot/ankle/leg that resulted in long-term problems or deformity? Yes Please specify 6. Any childbirth? (For female patient) Yes, a.. of children: b. Any noticeable worsening of your bunion soon after giving birth: ; Yes

2 7. Do you have flat foot? / Don t know Yes: a. When did you notice it? Before; After your bunion deformity. b. Do you wear foot orthotics? ; Yes Office Use: Name : ; Ref. #: ; Date of surgery : ; Date of follow-up: ;. of months in follow-up:

3 Research questionnaire for Dr. Wu s non-bone-breaking surgery Part 2. Your Foot condition before surgery Right Foot; Left Foot 1. Pain: Yes a. Location ( may select more than one ): Bunion; Big toe joint; Under forefoot; Small toe side; Leg; Hip; Low back b. Indicate overall severity (please circle one number only): (Min. Pain) (Worst possible pain) c. When do you usually feel it? i. Almost constantly ii. Walking with: high-heels; tight shoes; any shoes; no shoes iii. n-specific 2. Calluses: Yes: a. Location (may select more than one): Under forefoot; Big toe; little toe; Other: b. Are they painful? ; Yes, where c. Do you pare them regularly? ; Yes 3. Activity limitation from your bunion condition. limitation. limitation of daily activities, limitation of recreational activities. Limited daily and recreational activities. Severe limitation of daily activities.

4 4. Any other deformities of your foot? ; Yes: Over-lapping toes; Clawed/hammer toes; Bunionette (of little toe) 5. Your reason(s) for surgery: (Please select ONE ONLY) Cosmetic To solve the problem on shoes selection Pain Other: please specify:

5 Right Foot; Left Foot 1. Pain: Yes a. Location ( may select more than one ): Bunion; Big toe joint; Under forefoot; Small toe side; Leg; Hip; Low back b. Indicate overall severity (please circle one number only): (Min. Pain) (Worst possible pain) c. When do you usually feel it? i. Almost constantly ii. Walking with: high-heels; tight shoes; any shoes; no shoes iii. n-specific 2. Calluses: Yes: a. Location (may select more than one): Under forefoot; Big toe; little toe; Other: b. Are they painful? ; Yes, where c. Do you pare them regularly? ; Yes 3. Activity limitation from your bunion condition. limitation. limitation of daily activities, limitation of recreational activities. Limited daily and recreational activities. Severe limitation of daily activities. 4. Any other deformities of your foot? ;

6 Yes: Over-lapping toes; Clawed/hammer toes; Bunionette (of little toe) 5. Your reason(s) for surgery: (Please select ONE ONLY) Cosmetic To solve the problem of shoes selection Pain Other: please specify: Part 3. Physical Examination Findings ***** Office Use Only ***** 1. 1st MPJ: Extension+Flexion: <30 < < 75 < 2. Lesser toe clawing deformity:, Yes: Flexible, Rigid 3. Callus: Metatarsal: cm Hallux, Lesser toes:, Bunionette 4. X-ray: 1st MPA:, IMT:, Declination:, Sesamoid:

7 Research questionnaire for Dr. Wu s non-bone-breaking surgery Part 4. Your Foot condition after surgery Right Foot; Left Foot 1. Cosmetic improvement: Very much; Moderate; Slight; t at all 2. Pain: ne; Much less; Moderately less; Slightly less; change; Worse 3. Walking: Much better/stronger; Moderately so; Slightly so; difference; Worse 4. Shoes now you usually wear (please select one only): Any style (include high heels and fashionable shoes); Regular shoes with heels 2 ; Need to wear comfortable type of shoe to avoid residual discomfort; Comfort shoes only for residual pain. 5. Calluses: a. Big toe: none; less; same; worse b. Under forefoot: none; less; same; worse c. Little toe: none; less; same; worse d. Other: 6. Current sports/exercise: ne; Jogging; Dancing; Hiking; Tennis; Any Problem? Other ; Yes: What?

8 7. Limitation of your daily activity after surgery: limitation limitation of daily activities, limitation of recreational activities Limited daily and recreational activities Severe limitation of daily activities 8. Overall result: Very satisfied (would recommend to others) Moderately satisfied (would still choose over bone-breaking method) t satisfied (would consider bone-breaking surgery instead) Dissatisfied (would speak against it) 9. Please state any dissatisfactions:

9 Right Foot; Left Foot 1. Cosmetic improvement: Very much; Moderate; Slight; t at all 2. Pain: ne; Much less; Moderately less; Slightly less; change; Worse 3. Walking: Much better/stronger; Moderately so; Slightly so; difference; Worse 4. Shoes now you usually wear (please select one only): Any style (include high heels and fashionable shoes); Regular shoes with heels 2 ; Need to wear comfortable type of shoe to avoid residual discomfort; Comfort shoes only for residual pain. 5. Calluses: a. Big toe: none; less; same; worse b. Under forefoot: none; less; same; worse c. Little toe: none; less; same; worse d. Other: 6. Current sports/exercise: ne; Jogging; Dancing; Hiking; Tennis; Any Problem? Other ; Yes: What?

10 7. Limitation of your daily activity after surgery: limitation limitation of daily activities, limitation of recreational activities Limited daily and recreational activities Severe limitation of daily activities 8. Overall result: Very satisfied (would recommend to others) Moderately satisfied (would still choose over bone-breaking method) t satisfied (would consider bone-breaking surgery instead) Dissatisfied (would speak against it) 9. Please state any dissatisfactions: Part 5. Physical Examination Findings ***** Office Use Only ***** 1. 1st MPJ: Extension+Flexion: <30 < < 75 < 2. Lesser toe clawing deformity:, Yes: Flexible, Rigid 3. Callus: Metatarsal: cm Hallux, Lesser toes:, Bunionette 4. X-ray: 1st MPA:, IMT:, Declination:, Sesamoid:

11 Part 1 Personal Information Q1 Bunion Duration Bunion Duration <5 yr 5-8 yr 9-12 yr yr yr 0% yr yr yr yr >36 yr 2% 20% 19% 26% 8% 10% 1% 2% 8% 0% 7% 1 1% 8% <5 yr 6% 5 8 yr 20% 9 12 yr yr 10% yr 19% 8% yr yr Family History 26% yr Q2 Yes t sure Family History Yes t sure % Yes Yes t Sure 14% % t Sure Q3 Did you wear high-heel shoes at all? (For female patient) Yes 27% 73% Duration Usual height of the high heel heel Q3.1a < >36 0 8% 15% 25% 8% 21% 4% 4% 13% 2% 2% 3% 3% Q3.1b Frequency 15% about 3 once a 21% Daily days/week week less 33% 34% 5% 28% 1 14% Q3.1c Usaul height of the high-heel 44% 1"-1.5" 1.6"-2" 2.1"-2.5" 2.5"-3" 3.1"-3.5" >3.5" 15% 44% 14% 21% 3% 3% 1 1" 1.5" 1.6" 2" 2.1" 2.5" 2.5" 3" 3.1" 3.5" >3.5"

12 Q4 Sports & Exercises Swim ne Jogging Dancing Hiking Tennis Golf Tai-chi Yoga Badmin Others ming 33% 18% 9% 13% 6% 3% 4% 2% 2% 3% 7% Q5 Any trauma that resulted in long-term problems or deformity? Yes 88% 12% Q6 Q6.1a Q6.1b Any childbirth? Yes 36% 64%. of children: % 46% 8% 6% Any noticeable worsening of your bunion soon after giving birth: Yes 75% 25% Q7. Flat foot? Yes 67% 33% tice it (before or after) your bunion deformity Q7.1 Before After 43% 57% Wear foot orthotics. Q7.2 Yes 41% 59%

13 Part 2 Both Foot condition before the surgery Q1. Pain Q1.1 Yes 2% 16% 84% Pain Location Under Small Toe Low Bunion Big Toe Joint Forefoot side Leg Hip Back Q1.2 28% 24% 20% 11% 10% 2% 5% Indicate overall severity % 10% 20% 5% Pain Location 28% 24% Bunion Big Toe Joint Under Forefoot Small Toe side Leg Hip Low Back 0% 4% 13% 15% 17% 10% 19% 17% 3% 3% When do you usually feel it? Q1.3 When do you usually feel it? Walking with Constantly shoes n-specific 28% 51% 21% Q1.3a Walking with : High-heels h Tight shoes Any shoes shoes 34% 39% 26% 1% 21% 51% 28% Constantly Walking with shoes nspecific Q2. Calluses Q2.1 Yes 18% 82% Q2.2 Calluses Location Ud Under Forefoot Big Toe Little Toe Fourth Toe Others 50% 31% 16% 1% 2% Q2.3 Are they painful? Yes 50% 50% 82% Calluses 18% Yes Calluses location 1% 2% 16% 50% 31% Under Forefoot Big Toe Little Toe Fourth Toe Q2.4 Do you pare them regularly? Yes 35% 65%

14 Q3 Activity i limitation i i from your bunion condition. i Limitation in Limitation in Severe limitation Recreational Daily Limitation Sports Activities i i 20% 19% 47% 14% Q4. Any other deformities of your foot? Yes Q4.1 61% 39% Over-lapping Claw/hammer toe Toe Bunionette 68% 19% 13% 47% 14% Limitation on activities 20% 19% limitation Limitation in Recreational Sports Limitation in Daily Activities Severe Limitation Other deformities 13% Over lapping toe 19% Claw/hamme r Toe 68% Bunionette Q.5 Your reason for surgery? Cosmetic Problems with shoes Pain Others 9% 32% 56% 3% 56% Reason for sugery 3% 9% 32% Cosmetic Problems with shoes Pain Others

15 Part 3 Both Feet after surgery Q1. Cosmetic improvement 0% Q2. Pain Very much Moderate Slight t at all 57% 34% 9% 0% ne or 34% very much Moderately Md less less Slightly less change Worse 88% 5% 5% 1% 1% Cosmetic Improvement 9% 57% Very much Moderate Slight t at all 4% 35% Improvement in walking 1% 1% Much better Moderately so Slightly so 59% difference Worse Q3. Improvement in walking Much better Moderately so Slightly so difference Worse 58% 35% 4% 1% 1% 1 5% 5% Q4. Shoes now you usually wear? Q5. Calluses Comfortable Comfortable Special Any Style type by choice type by need shoes only 32% 38% 27% 2% Q5.1 Big Toe ne Less Same Worse 39% 44% 12% 5% Q5.2 Under Forefoot Q5.3 ne Less Same Worse 59% 33% 8% 0% Little Toe ne Less Same Worse 45% 34% 20% 1% 1% Pain Shoes now you usually wear 33% 1% 88% Calluses Forefoot 8% 0% 59% ne or very much less Moderately less Slightly less change Worse ne Less Same Worse 27% 3% 38% 32% Any Style Comfortable type by choice Comfortable type by need Special shoes only

16 Q6. Q6.1 Current Sports/Exercises ne Jogging Dancing Hiking Tennis Golf Swimming Yoga Taichi Badminton Other Q6.2 25% 32% 7% 14% 2% 1% 6% 3% 2% 4% 4% Any problems Yes 89% 11% Current Exercise Activities 3% 2% ne 4% Limitation on Jogging Limited Daily Severe 1% Activities 7% 26% Dancing limitation Activities Limitation 2% ONLY Hiking 78% 12% 9% 1% Tennis 14% Golf 12% Swimming 8% 33% Yoga Q7. Activities Q8. Overall Result Very Moderately satisfied satisfied t satisfied Dissatisfied 77% 21% 1% 1% Taichi Badminton 9% 1% 78% limitation Limitation on Activities ONLY Limited Daily Activities Severe Limitation 1% 1% Overall Result Very satisfied 21% Moderately satisfied t satisfied 77% Dissatisfied

Bunions. A bunion is a painful bony bump that develops on the inside of the foot at the big toe joint. Bunions are often referred to as hallux valgus.

Bunions. A bunion is a painful bony bump that develops on the inside of the foot at the big toe joint. Bunions are often referred to as hallux valgus. Bunions A bunion is a painful bony bump that develops on the inside of the foot at the big toe joint. Bunions are often referred to as hallux valgus. Bunions develop slowly. Pressure on the big toe joint